BMJ 2003;326:416 ( 22 February )
Tim Radford Denver
The US health system is itself sick and needs a national commission to get it back on the road to recovery, Floyd Bloom, president of the American Association for the Advancement of Science, told the association’s annual meeting last week.
Dr Bloom is the head of neuropharmacology at the Scripps Research Institute, La Jolla, California. He was editor in chief, until 2000, of the journal Science, and he once headed the neuropharmacology laboratory at the National Institutes of Health. That an architect of modern neuroscience chose to open the largest single public science conference in the United States to make his point suggests more than just a cautionary diagnosis.
Dr Bloom warned of soaring health premiums, shortages of expertise in a number of specialties, paperwork burdens, and archaic methods of information management. And he had more immediate problems in mind. "The threat of war and the imposition of mass casualties from any new acts of terrorism could prove calamitous for the US medical community’s ability to care for the ill," he said.
He listed specific problems. Communication was difficult. The number of drugs available to treat an increasingly elderly population had passed the 10 000 mark. Many of these drugs had covert interactions between them. Patients were seeing several doctors, who did not know about each other and who were prescribing drugs that may be mutually antagonistic or toxic.
"So there is a great need for stepping back from this crisis situation and finding ways to re-examine the decisions that we have made and the choices that we have in the future," he said. "Unless we do something now, all of the doubling of the NIH’s [National Institutes of Health] research resources . . . will have a difficult time making it through the pipeline to reach the bedsides of the patients," he said. Genomic research was unlikely to provide any dramatic benefits for many years, but it distracted from the problems multiplying right now.
He also raised the problems that stress in infancy might impose in later life for millions of Americans. "Stress is the name we give to a natural reaction our bodies generate when we encounter a situation that is unbeknownst to us," he said. "We activate our autonomic nervous system, and as a result our blood pressure goes up, our heart rate goes up, our blood glucose goes up, and our blood lipids go up. All of which is a great advantage if you are trying to flee from a threatening situation.
"But if stress is maintained, what results is a change in our metabolism which permanently results in hyperglycaemia, down-regulation of insulin receptors, deposits of lipids from those high lipids in the bloods into the endothelial cells of the capillaries. And prolonged stress of itself is a major factor in the onset of type 2 diabetes, hypertension, cardiovascular illness, and various problems of modern society."
He then turned his attention to what he described as the "reactive" health system in the United States.
"We wait until somebody is sick, and then we try to do something about it. Preventive medicine has a great deal to offer. Socioeconomic status has important proclivities for a host of illnesses in our country, including osteoarthritis. The lower you are in the socioeconomic status scale, the more likely you are to have osteoarthritis, or asthma, or other kinds of pulmonary illnesses," he said.
[Karl Note: All these criticisms are valid -- but he misses the most basic. Modern medicine is moving in the wrong direction and will not improve no matter what is done -- chemical medicine is bankrupt!]
"We can’t declare poverty to be gone. But we can recognise what the factors are and try to apply what we have today—instead of waiting for molecular discoveries to tell us how we might tailor drugs at some point in the future."
Tim Radford is science editor of the Guardian.
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